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Guidelines for Ordering Blood for Elective Surgery


Also Referred to as Maximum Surgical Blood Order Schedule (MSBOS)

These guidelines present a range in numbers of units of blood to be ordered as practiced at three different institutions: University Hospital State University of New York Upstate Medical Center at Syracuse, New York; Virginia Commonwealth University Medical Center, Richmond, Virginia; and University of Michigan Hospitals, Ann Arbor, Michigan. Each institution should set its own guidelines for ordering blood products to take into account varying medical needs and practices in collaboration with the hospital medical and surgical staff.

KEY:

  • 0 = no testing required

  • T&S = type and screen

  • 1-6 = number of units crossmatched

  • AO = as ordered

  • ∗ = varies with purpose

Cardiopulmonary/Cardiothoracic

  • A-V canal repair 3

  • Angioplasty T&S

  • Aortic or ventricular aneurysm repair 4

  • Aortic dissection/repair 6

  • Aortic valve replacement 2 to 3

  • Atrial septal defect repair 2

  • Atrial septectomy 2

  • Blalock-Taussig shunt 1

  • Bidirectional Glenn’s shunt 2

  • CABG (coronary vein graft)

    • Off pump T&S

    • On pump 2

  • Coarctation repair 2

  • Esophagogastrectomy 3

  • Esophageal hernia/hiatal T&S

  • Esophagoscopy T&S

  • Fontan’s procedure 3 to 4

  • Great vessel switch 3

  • Lobectomy T&S

  • Mediastinoscopy T&S

  • Mitral commissurotomy 2

  • Mitral valvuloplasty 2

  • Mitral valve annuloplasty 2

  • Mitral valve replacement 2

  • Mustard procedure 2

  • Open lung biopsy T&S

  • Pacemaker insertion T&S

  • Patent ductus arteriosus ligation T&S

  • Pericardectomy 2

  • Pericardial window T&S

  • Pneumonectomy T&S

  • Pulmonary valve replacement 2

  • Pulmonary valvulotomy 2

  • Redo and repair 6

  • Septectomy 2

  • Sternal wire removal 0

  • Tetralogy of Fallot 2

  • Thoracotomy/lobectomy T&S

  • Thoracoscopy T&S

  • Transposition repair 2

  • Ventricular septal defect repair 2

  • Wedge resection T&S

General Surgery

  • Abdominoperineal resection T&S

  • Amputations T&S

  • Appendectomy 0

  • Bronchoscopy T&S

  • Catheter insertion/removal 0

  • Cholecystojejunostomy T&S

  • Cholecystectomy 0

  • Colon resection T&S

  • Colostomy closure/takedown T&S

  • Debridement (wound, burn) AO

  • Denver peritoneal shunt insertion T&S

  • Denver shunt revision T&S

  • Dressing change 0

  • Exploratory laparotomy T&S to 2

  • Gastric bypass T&S

  • Gastrostomy tube insertion 0 or T&S

  • Hemicolectomy T&S

  • Hemorrhoidectomy 0

  • Hepatic lobectomy 4

  • Hernia repair, inguinal 0

  • Ileostomy T&S

  • Iliac profunda bypass 2

  • Jejunostomy tube placement 0

  • Lumpectomy, breast mass 0

  • Mastectomy, simple 0

  • Mastectomy, modified radical 0

  • Mastectomy, radical T&S

  • Mediastinoscopy 0

  • Myotomy (pyloric) 0

  • Parotidectomy 0

  • Pilonidal cyst 0

  • Portocaval shunt 4 to 6

  • Pseudoaneurysm repair 4 to 6

  • Rib resection 0

  • Sigmoidectomy T&S

  • Sigmoidoscopy 0

  • Small bowel resection T&S

  • Splenectomy T&S to 2

  • Sympathectomy T&S

  • Thyroidectomy 0

  • Total colon resection T&S

  • Transjugular intrahepatic portosystemic shunt (TIPS) T&S

  • Vagotomy 0

  • Vein stripping T&S

  • Whipple’s procedure 2 to 4

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